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Neurology (Expert Forum)
drug interaction?
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drug interaction?
by Lyn2, Apr 12, 2001 12:00AM
I realize that most of the people that post questions on this forum have significant problems. I don't think mine is that big a deal but I do have some questions. I am a 32yr. old female. I take the following medications mostly for heart, Amiodarone, Coumadin, Lasix, potassium, zoloft, cardizem, miacalcin.
I started taking amiodarone about four months ago. I don't know exactly how long ago, but I noticed that if I was sitting with my feet on the floor and one of my kids walked by about 5 feet away, the slight vibration in the floor would cause my leg to go up. Also I suddenly jump for no reason. Like my arm or leg will go up. If I put my hand down on my thigh my leg jumps up from the floor. The only other thing is every night when I go to bed, both arms simultaneously, from the pinky finger and ring finger all the way up to my elbow become numb, one time it stayed completely numb for 24 hours. At the same time my arms get numb my toes get numb and cold. I wake up in the morning trembling.
Sorry so long. When I went to see my internist I simply mentioned being a bit jumpy (not at all anxious) and he did a few reflex tests and said I was extremely hyperreflexive and he told me to see a neurologist. My cardiologist insisted as well.
So the questions are. Do you think it is really necessary to be evaluated by a neurologist? Could this be nothing?
Is it possible that the amiodarone is causing this reaction? My cardiologist didn't seem to think so, but said if it was that it would probably progress if I wasn't taken off it. Is this true?
What are the things the neurologist will be looking for to dtermine the cause? Any specific tests? I have a pacemaker, so cant have MRI.
How will he determine if it is the medication, and if it isn't what are other possibilities?
I still haven't decided if I am going to the neurologist, but maybe a little insight would help make my decision. Sorry to long. I hope the information I provided was relevant. Thank you so much for this service. Oh one last thing. About 1 year ago I suffered a few TIAs as a result of heart ablations and pacemaker placement.
Thankyou
I started taking amiodarone about four months ago. I don't know exactly how long ago, but I noticed that if I was sitting with my feet on the floor and one of my kids walked by about 5 feet away, the slight vibration in the floor would cause my leg to go up. Also I suddenly jump for no reason. Like my arm or leg will go up. If I put my hand down on my thigh my leg jumps up from the floor. The only other thing is every night when I go to bed, both arms simultaneously, from the pinky finger and ring finger all the way up to my elbow become numb, one time it stayed completely numb for 24 hours. At the same time my arms get numb my toes get numb and cold. I wake up in the morning trembling.
Sorry so long. When I went to see my internist I simply mentioned being a bit jumpy (not at all anxious) and he did a few reflex tests and said I was extremely hyperreflexive and he told me to see a neurologist. My cardiologist insisted as well.
So the questions are. Do you think it is really necessary to be evaluated by a neurologist? Could this be nothing?
Is it possible that the amiodarone is causing this reaction? My cardiologist didn't seem to think so, but said if it was that it would probably progress if I wasn't taken off it. Is this true?
What are the things the neurologist will be looking for to dtermine the cause? Any specific tests? I have a pacemaker, so cant have MRI.
How will he determine if it is the medication, and if it isn't what are other possibilities?
I still haven't decided if I am going to the neurologist, but maybe a little insight would help make my decision. Sorry to long. I hope the information I provided was relevant. Thank you so much for this service. Oh one last thing. About 1 year ago I suffered a few TIAs as a result of heart ablations and pacemaker placement.
Thankyou
Doctor's Answer
by CCF Neuro[P]-M.D.-RPS, Apr 12, 2001 12:00AM
Dear CN:
Sorry that your have symptoms that distrub you. Amidorone is know to cause a peripheral neuropathy and tremor. However, what you are describing is a hyperreflexia. Amidorone is likely not the cause, we have seen many, many patients with tremor at rest, loss of feelings, weakness, loss of reflexes, sensory changes-like pain, etc. I would strongly recommend that you see a neurologist. Hyperreflexia is usually due to a problem in the spinal cord or brain. One needs to do a detailed neurological exam to see if your also have spasticity, Babinski sign, and other symptoms of an upper motor lesion. Whether this is a new problem or related to your TIA or maybe strokes needs to be uncovered.
Sincerely,
CCF Neuro MD
Sorry that your have symptoms that distrub you. Amidorone is know to cause a peripheral neuropathy and tremor. However, what you are describing is a hyperreflexia. Amidorone is likely not the cause, we have seen many, many patients with tremor at rest, loss of feelings, weakness, loss of reflexes, sensory changes-like pain, etc. I would strongly recommend that you see a neurologist. Hyperreflexia is usually due to a problem in the spinal cord or brain. One needs to do a detailed neurological exam to see if your also have spasticity, Babinski sign, and other symptoms of an upper motor lesion. Whether this is a new problem or related to your TIA or maybe strokes needs to be uncovered.
Sincerely,
CCF Neuro MD
May I ask what type of problem you have with your heart that has caused you to require a pacemaker at such a young age? I am curious because My father died at 42 from his 8th heart attack and my mother who recently passed away at age 69, had a pacemaker implanted at age 50 and had abalatins done as well..She was on the same drug and her list of drugs was almost identical to yours. After her abalation they put her on Amarodone(Spelling??)she also began to have the same problems and her left hand became numb and stayed that way..She also had frequent TIA's due to the irregular heartbeat. They gave her coumadin to help but it did not prevent them completely..When she died they thought she had a seizure/strike/Heart Fibrilattion type episode. So in my humble opinion it could be the medications or a combination thereof.
Take care of yourself and I wish you the best...Betty
I am so sorry to hear about your mother. It must be such a difficult thing not to know exactly what the cause was of her death. It does sound like she had a myriad of arrythmia problems. Did she have atrial fibrillation. That is the rhythm I have right now which has forced me to take coumadin for the rest of my life. I got my pacemaker because when they did ablations to get rid of an arrythmia it caused such a drastic reduction in my heart rate from 140bpm before the procedure to 10 to 30bpm a few weeks after the procedure.
I have heard that atrial fibrillation responds well to amiodarone, but it does have many side effects some of which are serious. Usually you hear about thyroid or lungs or liver (I am getting a bit of toxicisity in my liver). I was asking the doctor about neuro. because I am not familiar with the problem I am having now. Unfortuneatly I could tell you anything you need to know about heart rhythm problems (I've had them all) but not much about neurology. Hoping I don't have to learn much, as there hopefully is nothing to worry about. Thanks for your comments.
It is very hard not knowing for sure why my mother died, She was actually fine one day and gone the next. She did have Atrial Fib thats why she had the abalation. But her situation was reverse from yours she got the pacepacker at 50 due to too slow of a heart rate and cardiac arrest due to that slow beat. One day she was okay next day cardiac arrest. She had sick sinus sydrome they say. So they put in the pacer...She did well for many years and developed Diabetes and then suddenly the opposite Atrial Fib..It caused her to have Heart Failure several times and get very ill..Coumadin was given as well as asprin. She has good periods and bad..about 2 years ago her memory started to fail and she started to lose balance and such..They said small lacunar infarcts age related changes per se..Then they said small strokes..They did the Abalation put her on Amarodone and she had the same troubles you describe. They finally took her off of it. But the numb hand persisted and never felt right..she did well for a while.
Have you had a MRI, did they see any evidence of stroke? I know TIA does not show up. What was the cause of your heart rate disturbance did they ever find out?
Feel free to e-mail me at
***@**** or ***@****
Take Care
Betty